This is apparently a big issue here, on the scale of tobacco use. There are signs over the hospital and in the car that picked us up from the airport warning not to chew betel nut. This phenomenon involves a nut that grows on a palm tree, that is sliced and chewed along with pieces of betel leaf and/or tobacco leaf and lime juice for flavor. It supposedly has a mild peppery taste and is known to be a human carcinogen much the same as chewed tobacco is. It also has an added effect of dying the teeth, gums, and lips red, and producing a large quantity of reddish brown spit (as found in all the hospital's restroom trash cans).
Yeah, some older Vietnamese people also chew betel nut. It turns their teeth a brownish black which was culturally desirable. Supposedly it prevented cavities too! My grandma did some of that when she was alive, but wasn't very hardcore so her teeth light brown. Good thing because it's carcinogenic!
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